The level of urbanization influences acute ischemic stroke care: A nationwide ecological study from Germany,Journal of the Neurological Sciences

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The level of urbanization influences acute ischemic stroke care: A nationwide ecological study from Germany
Journal of the Neurological Sciences ( IF 3.6 ) Pub Date : 2021-09-13 , DOI: 10.1016/j.jns.2021.119983
Daniel Richter ₁ , Jens Eyding ₂ , Ralph Weber ₃ , Dirk Bartig ₁ , Björn Misselwitz ₄ , Armin Grau ₅ , Christos Krogias ₆

Affiliation

Background and purpose

Regional differences in acute ischemic stroke (AIS) care are still reported for Germany but not fully understood. We aimed to analyze the impact of the level of urbanization on the application of proved treatment procedures and the incidence of hospitalized AIS cases in Germany.

Methods

The level of urbanization of the 401 districts and district-free cities in Germany was defined according to the Federal Institute for Building, Urban Affairs and Spatial Research classification. Using nationwide administrative data, the application of intravenous thrombolysis (IVT), mechanical thrombectomy (MT), and the incidence of hospitalizations for AIS, were analyzed according to the place of residence of the patients. Data included all patients hospitalized for AIS in 2019 (n = 224,274) and sociodemographic information of 83,019,213 residents in Germany.

Results

Sparsely populated districts had a significantly higher incidence of hospitalizations for AIS than cities (age-standardized: 271.8 versus 242.3 per 100,000 inhabitants, P < 0.001), but a lower use of MT (5.7% versus 8.4%, P < 0.001). In the adjusted negative binomial regression model, rurality remained an independent predictor for MT use and the incidence of AIS hospitalizations. The proportion of IVT did not significantly differ between sparsely populated districts and cities (15.6% versus 17.2%, P = 0.021).

Conclusions

Although there is a dense network of stroke units in Germany, the level of urbanization still influences AIS care, as we found a lower proportion of MT and a higher incidence of AIS hospitalizations in Germany's rural areas.

中文翻译：

城市化水平对急性缺血性卒中护理的影响：来自德国的全国生态研究

背景和目的

德国仍报告了急性缺血性卒中 (AIS) 护理的地区差异，但尚未完全了解。我们旨在分析城市化水平对德国经证实的治疗程序的应用和住院 AIS 病例发生率的影响。

方法

德国 401 个区和无区城市的城市化水平是根据联邦建筑、城市事务和空间研究所分类确定的。使用全国行政数据，根据患者的居住地，分析了静脉溶栓（IVT）、机械取栓（MT）的应用以及AIS住院的发生率。数据包括 2019 年因 AIS 住院的所有患者 ( n = 224,274) 和德国 83,019,213 名居民的社会人口学信息。

结果

人口稀少地区的 AIS 住院率明显高于城市（年龄标准化：每 100,000 居民 271.8 对 242.3，P < 0.001），但 MT 的使用率较低（5.7% 对 8.4%，P < 0.001）。在调整后的负二项式回归模型中，农村地区仍然是 MT 使用和 AIS 住院发生率的独立预测因素。IVT 的比例在人口稀少的地区和城市之间没有显着差异（15.6% 对 17.2%，P = 0.021）。